This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Monday, August 26, 2013

Weekly Australian Health IT Links – 26th August, 2013.

Here are a few I have come across the last week or so.

Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

Worst bit of news this week was the article showing the senior DoHA executives were getting nice bonuses as hundreds of staff are being fired. Hardly a good look.

Otherwise we see the Qld Payroll debacle finally played out with some accountability imposed on a few bureaucrats. I wonder will we ever see anything flow from the PCEHR debacle.

Last we have continuing outcomes from the clinical resignations from NEHTA. I suspect there will be ongoing news and ructions from this.

THE health department has rejected allegations that Australians signing up to the personally controlled e-health record (PCEHR) have been encouraged to do so without being given fully informed consent regarding how their information will be used.

The Australian Privacy Foundation (APF) said the PCEHR had been designed “to suit the needs of government, not patients”.

“Patients demand a careful balance between their rights to privacy and the government’s insatiable desire to collect, control and exploit personal data,” the APF said yet.

Dr Mukesh Haikerwal (pictured) was head of clinical leadership at NEHTA for six years, but last week it emerged he had resigned along with other senior members of NEHTA's clinical unit, which had been set up to provide oversight and clinical input into the system.

In a statement, the former AMA president said: "My decision to move on from my role with NEHTA has not been made lightly, and of course there is never a 'good time' to take this step.

"However, with the e-health system now in its current place and moving into a different phase, this is the right time for me to step aside."

Australian Medical Association President, Dr Steve Hambleton, has responded to the resignation of Dr Mukesh Haikerwal, head of clinical leadership and stakeholder management, from the National Electronic Health Transition Authority (NEHTA).

In a statement Dr Hambleton said it raises serious concerns about clinical input to decision-making in the implementation of the Personally Controlled Electronic Health Record (PCEHR).

The resignations of Dr Haikerwal, a former AMA President and NHHRC Commissioner, and other clinical leads, including Dr Nathan Pinksier, come amid reports that the Department of Health and Ageing (DoHA) is taking over engagement with the medical profession and IT industry over the design of the PCEHR.

news Shadow Health Minister Peter Dutton has taken a pickaxe to the Federal Government’s Personally Controlled Electronic Health Record (PCEHR) scheme, claiming the costly project was “more about spin than about outcomes for patients”.

The project was initially funded in the 2010 Federal Budget to the tune of $466.7 million after years of the health industry and technology experts calling for development and national leadership in e-health and health identifier technology to better tie together patients’ records and achieve clinical outcomes. The project is overseen by the Department of Health and Ageing in coalition with the National E-Health Transition Authority (NEHTA).

The PCEHR belongs to Australians, not the government. It is our tax money, our data, our health, our work. NEHTA and the Department of Health have not been able to manage the project successfully over the past years and the governance of the PCEHR should be handed over to an independent council as soon as possible.

The resignation of NEHTA’s top National Clinical Leads last week was the final straw. I have said it before and I will say it again: if clinicians are not on board the PCEHR will fail. There are some big decisions to make by the relevant authorities if they want to save the project, and making these decisions without clinical advice is impossible.

A Federal Government plan to extract pathology results from GP software and upload them onto the billion-dollar e-health scheme is sparking fears about patient safety.

The idea was apparently hatched by NEHTA and the Department of Health and Ageing without consultation, but is meant to help doctors and other health professional using the personally controlled e-health records system improve patient care.

However, pathologists and GPs have pointed out that uploading the results would give an incomplete and potentially misleading clinical picture, given the wide variations in the methods of pathology reporting.

A growing number of practices are offering online services that benefit their patients and their business.

General practices used to only interact with patients in person or over the phone. Now they’re starting to offer online services through their websites, including booking appointments and receiving test results, referral letters and repeat scripts.

Bondi Junction Medical Centre in Sydney began offering online services in March and the experience has been highly satisfying, says practice manager Rakesh Vyasabhattu.

The benefits reaped by the GPs are primarily time saved and extra income. For example, the GP and patient agree beforehand that test results will be available online for the set fee of $20.

The Australian Medical Association (AMA) has held crisis talks with the head of the federal Department of Health and Ageing, Professor Jane Halton, over the unprecedented walkout of clinical advisors from the nation’s decade long $1 billion effort to build a functional eHealth system.

Held on Tuesday, the meeting followed calls by AMA president Dr Steve Hambleton for Professor Halton to intervene and take a “personal focus” on why highly respected eHealth clinical advocate Dr Mukesh Haikerwal and several other medical advisors suddenly parted company with National eHealth Transition Authority (NeHTA) after a decade of attempting to make eHealth an everyday reality.

The situation that is emerging is that DoHA, assisted by contentious technology consulting and services firm Accenture, are poised to take on far more control and work to finally deliver software end-products to doctors and hospitals leaving an existential question mark over the future of NeHTA.

The promise of a personal medical record accessible to everyone involved in a patient’s health care sounds like a wonderful idea. And if the system actually worked – it would be! Tests wouldn’t be duplicated, hospitals would know the full list of diseases that the GP was treating and GPs would know all the medication changes that hospitals and specialists instigated.

Of course the more complex a system, the bigger the chances that something will go wrong. So the development of the PCEHR (Personally Controlled Electronic Health Record) was always going to be difficult. Medical groups were worried whether the information on the file would be accurate; IT experts were worried about whether the security levels would be robust enough; consumer groups wanted patients to be able to control who could and couldn’t have access to any aspect of the record.

The danger with a asking a committee to design a horse is that you end up with something that looks like a camel. Although the government invested close to a billion dollars developing the PCEHR system, nobody involved has been really happy with the outcome. Several hundred-thousand people have registered to enrol in the system but in fact less than 5000 GP-written health care summaries have been created across Australia.

Federal Health Minister Tanya Plibersek has made many decisions that have had a direct affect on general practice.

Is freezing patients’ Medicare rebates good for Australia’s health? What has been her biggest achievement? And what will she do to reduce red tape faced by doctors?

Australian Doctor asked the questions - here are her answers:

Aus Doc: You recently said that GPs were the “backbone of Australia’s world-class universal health system”. But the federal government will effectively cut the value of the funding for GP Medicare services with the indexation freeze.

It has already cut MBS funding for GP mental health items, as well as direct funds to GP practices for after-hours services. And has a plan to tax doctors’ CPD.

Is the government not in fact breaking the backbone of our world-class health system?

Plibersek: Government investment in primary care is at record highs, as is investment in the MBS. By increasing support for primary care, we’re better supporting the sector that has general practice at its heart. We have also been leading consultation with the profession about the possibility of a Patient Centred Medical Home model for general practice in Australia.

THE performance of airport body scanners and cancer diagnostic equipment could be boosted by about 50 per cent using a new technique to detect T-rays (terahertz waves).

Researchers are using a novel structure to trap terahertz waves in tiny, micro-scale holes to produce a much higher contrast image than currently possible.

Terahertz waves are electromagnetic waves with frequencies between those used for mobile phones and for optical-fibre communications. When used for cancer detection, they are capable of distinguishing malignant from healthy tissues. They are also used for security scanners to see through packages and clothes.

Objectives: To investigate whether General Practice Management Plans (GPMPs), Team Care Arrangements (TCAs) and reviews of these improve the management and outcomes of patients with diabetes when supported by cdmNet, a web-based chronic disease management system; and to investigate adherence to the annual cycle of care (ACOC), as recommended in diabetes guidelines.

Rhys Evans

OPINION

Microsoft's focus on the consumer market with Windows 8 left enterprise users in the lurch. That should change with Windows 8.1.

The enterprise adoption of Windows 8 hasn't been good news for Microsoft at all. At the end of last month it had single-digit market share and Windows 7 still dominated the desktop market. Many organisations still need to migrate from Windows XP before Microsoft ends support for it in April, but they're migrating from XP to the more familiar Windows 7, rather than the newer OS.

One enterprise bugbear has been the lack of a start button. Without that button, accessing the start screen from the desktop required a mouse click on the bottom left-hand corner of the screen, loading the charms bar from the right or pressing of the start key. On a touch-screen device without mouse or keyboard this was difficult and not intuitive.